Anesthesiology will exist as a medical specialy. I urge strong consideration for a fellowship.

Incomes will drop over time. The field has peaked in terms of money. There are still pockets of great practices with low Medicare/Medicaid and self pay. Those practices will endure the longest. However, Obamacare will eventually even get them. Resistance is futile. Obama wants cheap, cost effective care (which means cheap as possible).

CRNAs will not take over the fied completely. They may displace Physicans from the stool sitting role in some areas.

Yes, income could decrease to $200 for academia and $250-275 for private practice circa 2022. The problem with that income is inflation will have eaten away at the real value of that money by then. This translates into much lower income in today's dollars.

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man those don't seem like bad numbers at all.....granted we don't know what will happen with inflation, but I think 250-275 is what ppl in California and other popular locations are making TODAY. I think it's important for med students to enter the field expecting those kinds of numbers, and if things don't turn out to be as bad as ppl in sdn keep saying, well then anything more is gravy.

man those don't seem like bad numbers at all.....granted we don't know what will happen with inflation, but I think 250-275 is what ppl in California and other popular locations are making TODAY. I think it's important for med students to enter the field expecting those kinds of numbers, and if things don't turn out to be as bad as ppl in sdn keep saying, well then anything more is gravy.

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I'm neither a pessimist nor an optimist; I'm simply telling it as I see it.

$275 isn't enough for the cost of your education and sacrifices; but, if it works for you then so be it.

I'd like to see your medical tuition repaid if your payer mix is greater than 50% CMS/No pay. ObamaCare simply can't have its cake and eat it too.

Why should a USA trained Anesthesiologist make 40% less than his/her Canadian Colleague?

Who knows what the landscape will be 5 - 10 years down the road? CCM fellowships have been available for some time and it's been suggested here that it would be a wise idea as something to pursue (along with other fellowships) for training diversification. Does it seem incomprehensible that the field may be move more toward the direction of encompassing ICU/CCM - a la how it is in Europe/UK? I don't care what the job postings of today reflect. It's all about keeping an eye towards the future - there's a sea change going on.

Canadian Resident used to post here reported many starting jobs avail. in Canada at $350K. Also, my 40% discount figure refers to income in 2022. I wonder what Canadian Anesthesiologists will be earning in their currency vs. our devalued US Dollar? Perhaps, 40% was too generous and 50% would be a better number.

There are a lot of great things about Canada, although I wonder if one can easily adapt to the cold and lack of summers (about 1.5 months in most areas).

I am no Grey Owl, but I live in a cabin most of the year near Canada and even I have trouble with the cold. I have slept in 15 degree nights with 3 balaclavas on, and used a lake for water when I lost power.

Living in the cold is not so much fun or easy, unless you are born in the area or have family. This winter, I tried ice fishing, got extreme weather cold gear, but all in all I just kept thinking of summer and warmer weather. I suppose I could snowmobile more, but sailing, swimming or jet skiing is much, much better.

I just got out on my sailboat today and it was a joy. Of course I had a wetsuit on with boots and hoodies and could only last about 40 minutes.

Of course, some people like Richard Proenke survived happily in log cabins in Alaska - for me and most of my "Northern" friends we just simply are jealous of warm weather folks...

There are a lot of great things about Canada, although I wonder if one can easily adapt to the cold and lack of summers (about 1.5 months in most areas).

I am no Grey Owl, but I live in a cabin most of the year near Canada and even I have trouble with the cold. I have slept in 15 degree nights with 3 balaclavas on, and used a lake for water when I lost power.

Living in the cold is not so much fun or easy, unless you are born in the area or have family. This winter, I tried ice fishing, got extreme weather cold gear, but all in all I just kept thinking of summer and warmer weather. I suppose I could snowmobile more, but sailing, swimming or jet skiing is much, much better.

I just got out on my sailboat today and it was a joy. Of course I had a wetsuit on with boots and hoodies and could only last about 40 minutes.

Of course, some people like Richard Proenke survived happily in log cabins in Alaska - for me and most of my "Northern" friends we just simply are jealous of warm weather folks...

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I agree. That's why I will stay in the Southeast or Southwest. Think of the mason Dixon line as my border.

Today when I was doing a consult on a patient a CRNA came in to preop him for an endoscopy. She was asking me about lab values and in the course of the conversation she told me that CK was a more specific marker for the heart than CKMB. When I proceeded to clarify for her she then said, "Really? I did hearts for five years...are you sure?" and googled it on her phone.

Then she looked at the patients EKG, which was clearly a first degree block and said "first degree AV block" on it, and called it a Wenckebach, and to her credit described Wenckebach correctly...then writes down "Mobitz Type II" on her preop assessment.

Today when I was doing a consult on a patient a CRNA came in to preop him for an endoscopy. She was asking me about lab values and in the course of the conversation she told me that CK was a more specific marker for the heart than CKMB. When I proceeded to clarify for her she then said, "Really? I did hearts for five years...are you sure?" and googled it on her phone.

Then she looked at the patients EKG, which was clearly a first degree block and said "first degree AV block" on it, and called it a Wenckebach, and to her credit described Wenckebach correctly...then writes down "Mobitz Type II" on her preop assessment.

Then she looked at the patients EKG, which was clearly a first degree block and said "first degree AV block" on it, and called it a Wenckebach, and to her credit described Wenckebach correctly...then writes down "Mobitz Type II" on her preop assessment.

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Did she then call the urgent or emergent consult to cards for permanent pacemaker placement?

Included is this gem: Incorporated in 2005, Sweet Dreams Nurse Anesthesia, Inc. is proud to carry on the traditional anesthesia practice model, where nurse anesthetists collaborate with surgeons to provide the best anesthesia care possible.

Today when I was doing a consult on a patient a CRNA came in to preop him for an endoscopy. She was asking me about lab values and in the course of the conversation she told me that CK was a more specific marker for the heart than CKMB. When I proceeded to clarify for her she then said, "Really? I did hearts for five years...are you sure?" and googled it on her phone.

Then she looked at the patients EKG, which was clearly a first degree block and said "first degree AV block" on it, and called it a Wenckebach, and to her credit described Wenckebach correctly...then writes down "Mobitz Type II" on her preop assessment.

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If not for the AAs I'd think you were local to me.

Back in my well-intentioned but naive early-attendingship days (really not that long ago), I made an attempt to hold a benign M&M style 5-minute review with a few CRNAs to talk over a case that almost went very badly.

Beyond the resentment and simmering anger that I would dare to teach them anything, what was most disturbing was the dismissive way that one misidentified a Mobitz II as a 3rd deg block, yet still thought it was not a big deal in the context of that elective case.

Still, my favorite bad CRNA move of all time is the "move the ECG leads around to make the ST depression go away" stunt.

Back in my well-intentioned but naive early-attendingship days (really not that long ago), I made an attempt to hold a benign M&M style 5-minute review with a few CRNAs to talk over a case that almost went very badly.

Beyond the resentment and simmering anger that I would dare to teach them anything, what was most disturbing was the dismissive way that one misidentified a Mobitz II as a 3rd deg block, yet still thought it was not a big deal in the context of that elective case.

Still, my favorite bad CRNA move of all time is the "move the ECG leads around to make the ST depression go away" stunt.

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Like the new tagline, pgg, but I'm not sure I want to know who "the blind" are.

I would still be concerned.... Volume is not as important as the concept that they are able to provide equivalent care. If they can solidify that enough then the supply will rise to meet demand for cheaper labor.

Conversely, the American Association of Nurse Anesthetists referred to a study it financed that was published in Health Affairs in 2010. It examined Medicare data from 1999 to 2005 and found no evidence that opting out of the supervision requirement resulted in increased inpatient deaths or complications.
"When it comes to giving anesthesia, certified registered nurse anesthetists and anesthesiologists are identical," said Christopher Bettin, a spokesman for the nurse anesthetists group. "There are no differences in what they learn, the drugs and equipment they use and the standards of care they follow."

So did the CRNA salaries really go down and is the market really saturated 4 years out since this last post?

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CRNA salaries have been FROZEN or CUT in my state over the past 2 years. Several Groups cut CRNA pay by $15K while others froze the salary at 2012 levels.
There is a glut of CRNA labor out there and you can hire all the CRNA manpower needed pretty easily. So, the market is pretty saturated but a newly minted CRNA can still find employment with effort.

CRNA salaries have been FROZEN or CUT in my state over the past 2 years. Several Groups cut CRNA pay by $15K while others froze the salary at 2012 levels.
There is a glut of CRNA labor out there and you can hire all the CRNA manpower needed pretty easily. So, the market is pretty saturated but a newly minted CRNA can still find employment with effort.

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True in some markets.

I think the new CRNAs are not coming in at $140-150k like they did a few years ago. Most new ones are coming in at the $110-120k range. That's in a decent market. If they are willing to go work in BFE, then in some places the sky is still the limit.

The 2010 RAND report predicts a CRNAsurplus of over 4,000 practitioners, and still an anesthesiologist shortageof more than 3,000 by the year 2020. That is if you believe the 2010 RAND report.

I think the new CRNAs are not coming in at $140-150k like they did a few years ago. Most new ones are coming in at the $110-120k range. That's in a decent market. If they are willing to go work in BFE, then in some places the sky is still the limit.

The 2010 RAND report predicts a CRNAsurplus of over 4,000 practitioners, and still an anesthesiologist shortageof more than 3,000 by the year 2020. That is if you believe the 2010 RAND report.

Rand is wrong because supervision will increase from 2:1 to 4:1 by 2020 leaving a NET surplus of Anesthesiologists. The AANA is training all these CRNAs for an expected increase in demand via bigger coverage ratios. AMCs are turning to larger ratios and quasi independent CRNA practice for certain cases like Gi and Ob.

More certified nurse anesthetists (CRNA’s). It seems apparent that ObamaCare is interested in employing cheaper providers of medical services. CRNA’s will command lower salaries than anesthesiologists. The premise to be tested is whether CRNA’s can provide the same care for less money. Expect to see wider use of anesthesia care teams and of independent CRNA practice. Expect the overall quality of anesthesia care to change as more CRNA’s and less M.D.’s are employed.

Rand is wrong because supervision will increase from 2:1 to 4:1 by 2020 leaving a NET surplus of Anesthesiologists. The AANA is training all these CRNAs for an expected increase in demand via bigger coverage ratios. AMCs are turning to larger ratios and quasi independent CRNA practice for certain cases like Gi and Ob.

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As you probably already know I recently left a job that was already basically 4:1 most of the time. I assure you it wasn't just OB and GI that I was covering 4:1. Neurosurgery (cranis and all), complex vascular cases, etc.

That's a big reason why I left. It is ****ing scary what is going on out there. Major catastrophes waiting to happen. And I'm not going to be on the hook for that kinda thing. Put out fires, do papework, and expect CRNAs to simply figure out what's best. Based on what I saw no clue on how to properly manage the vent portion of the anesthetic with a sick patient. No idea what is "too much" narcotic for a case. 90 year olds getting midazolam and huge doses of ketamine and then I have to deal with them when they're completely bat**** in the PACU. You name it. Scary. Scarier most didn't call me because they either didn't know they were ****ing up the case or they didn't think they needed my help. 4:1 it is hard to do anything but keep the machine running let alone when you actually have a problem.

It's a huge ****ing social experiment that in any other instance we would need IRB approval and informed consent. Wake-up America.

114 CRNA schools in the US currently, thats about 1000 of them per year. As a resident I used to agonize about the future of our specialty.

Who knew it would be the AANA to the rescue for us. They have mandated the opening of so many schools, enough to flood the market. Most SRNA's I talk to at my program are having to move out of state BFE for jobs. They are complaining that signing bonuses are non-existant.

Like the 1990s for Anesthesiologists, supply will overwhelm demand, their salaries will go down.

With the DNAP coming in 2025, thats another year of VERY EXPENSIVE CRNA school. >100K in debt for salaries that will be <100K/year, plus the added malpractice insurance that independent CRNA's will have to pay. That adds up to not a whole lot more for your average nursing salary. Plus more stress and added hours vs your typical nursing job. And the AANA has no clout to close these CRNA mills, they are huge money makers for the institutions that run them.

These people have shot themselves in the foot. If anything we have provided the current generation of CRNA's the income and level of practice they enjoy. All it took was the AANA to get greedy.

I will still contribute to ASA-PAC as where anesthesiologists land in this debacle I'm still not sure, but the OR will always need physicians perioperatively.

But I at least can get comfort knowing that every time a CRNA tells me that he/she is equal to me, 15 years down the line, most will have rinky dink salaries lots of liability and debt levels that will dissuade more from entering the field. They always say they are cheaper "anesthesia providers", well they are about to get a whole lot cheaper.

Worst comes to worse and we do get replaced (we won't), I can at least do something else as a physician and maintain a decent salary. For nurses this is as good as it gets, but it won't last long.

Fight the good fight, contribute to the ASA-PAC, but know that in the end the AANA is doing more to hurt the CRNA practice than we ever could.

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I’m afraid I don’t understand your logic here. The oversupply of CRNAs may hurt CRNAs, but it doesn’t change the fact that CRNAs compete with anesthesiologists for jobs. And whether they have DNAP or WXYZ next to their names, they are essentially nurses with nursing degrees, and as such will never be offered nor will they expect the salaries anesthesiologists get. True, their salaries may go down because of the oversupply and DNAP requirement, but not enough to deter the average ICU nurse from the nursing dream of becoming a CRNA.

I’m afraid I don’t understand your logic here. The oversupply of CRNAs may hurt CRNAs, but it doesn’t change the fact that CRNAs compete with anesthesiologists for jobs. And whether they have DNAP or WXYZ next to their names, they are essentially nurses with nursing degrees, and as such will never be offered nor will they expect the salaries anesthesiologists get. True, their salaries may go down because of the oversupply and DNAP requirement, but not enough to deter the average ICU nurse from the nursing dream of becoming a CRNA.

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They do the above and they are aggressive about it….a large majority of them feel they bring the same skill set to the table as anesthesiologist and thus should be paid the same. Ridiculous I know but none the less they continue to make head way via legislative routes. Just remember all these same conversations have been happening since the 50-60s. Lets just say it doesn't hurt when the former presidents (BC) mother was a CRNA and much of the legislation that is supported by CRNA or any other midlevels also supported by the AHA. Below is a good read to give you an idea…comments are pretty enlightening as well.

The solution to this problem is exquisitely simple. The president, via his HHS Secretary, must eliminate reimbursement for medically directed anesthesia claims other than those incurred when teaching students or residents. All anesthesia professionals privileged to relieve pain and suffering should actually administer anesthetics. As a society we simply cannot afford to have highly trained anesthesiologists, whose residencies are financed by taxpayers, “supervising”. If a procedure requires multiple anesthesia providers due to surgical acuity or complexity, the current regulations provide for full reimbursement. The system currently incentivizes inefficiency without any gain in quality or safety, and potentially pays for services not rendered. This change eliminates the waste of millions or even billions of taxpayer-supported health care dollars and the submission of fraudulent claims. This would force anesthesia departments to become more efficient and allow all Americans to receive the same high level of care as our military heroes.

I am a CRNA who is responsible for proctoring a"experienced" BOARD CERTIFIED ANESTHESIOLOGIST to do nerve blocks. In addition this person is not comfortable with difficult airway scopes and equipment. This person frequently has failed labor epidural and spinal anesthetics. There are all kinds of levels of experience out there. This pissing match is getting so old. You guys are running scared. Stop the chest thumping rhetoric, No one cares you have PTSD from training and keep referring to it.. CRNA's despite less time in training are EQUALLY capable. Best wishes.

The solution to this problem is exquisitely simple. The president, via his HHS Secretary, must eliminate reimbursement for medically directed anesthesia claims other than those incurred when teaching students or residents. All anesthesia professionals privileged to relieve pain and suffering should actually administer anesthetics. As a society we simply cannot afford to have highly trained anesthesiologists, whose residencies are financed by taxpayers, “supervising”. If a procedure requires multiple anesthesia providers due to surgical acuity or complexity, the current regulations provide for full reimbursement. The system currently incentivizes inefficiency without any gain in quality or safety, and potentially pays for services not rendered. This change eliminates the waste of millions or even billions of taxpayer-supported health care dollars and the submission of fraudulent claims. This would force anesthesia departments to become more efficient and allow all Americans to receive the same high level of care as our military heroes.

This murse has obviously never set foot in a VA hospital and seen for himself what kind of "high level of care" the federal government has in mind for veterans. Anyone with a functioning eyeball would see exactly why CRNAs are so popular there.

The problem is that neither the general population nor the hospital administrators have any idea about the real difference between a good CRNA and a good anesthesiologist. We compare hours of training, procedures etc., but that's apples and oranges. We might all play baseball, but when the **** hits the fan, we are MLB and they are minor league.

We should make it clearer to the public that the reason you want an anesthesiologist is the same you want a Sully Sulberger as your pilot: for those rare situations when an "overtrained" physician will be the difference between life and death. The ASA should actively advertise to the general public that the healthcare industry is trying to make more profit by replacing anesthesiologists with CRNAs, risking lives, without decreasing healthcare costs to the patient. That's where I want to see the ASAPAC money going. Once the public opinion tide turns, the politicians will have no choice but to turn, too.

P.S. The VA is a disgrace. No quality care should ever be modeled on them. I felt so bad for those people, for how much they gave for us, and how little we do for them.

The problem is that neither the general population nor the hospital administrators have any idea about the real difference between a good CRNA and a good anesthesiologist. We compare hours of training, procedures etc., but that's apples and oranges. We might all play baseball, but when the **** hits the fan, we are MLB and they are minor league.

We should make it clearer to the public that the reason you want an anesthesiologist is the same you want a Sully Sulberger as your pilot: for those rare situations when an "overtrained" physician will be the difference between life and death. The ASA should actively advertise to the general public that the healthcare industry is trying to make more profit by replacing anesthesiologists with CRNAs, risking lives, without decreasing healthcare costs to the patient. That's where I want to see the ASAPAC money going. Once the public opinion tide turns, the politicians will have no choice but to turn, too.

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In the age of value based purchase the quality of your work is measured based on the metrics chosen by the government and the insurance industry, these metric do not reflect the actual quality of your work they actually do the oposite and make you look exactly equivalent to other kinds of providers.
It's unfortunately how the future is going to be.

The problem is that neither the general population nor the hospital administrators have any idea about the real difference between a good CRNA and a good anesthesiologist. We compare hours of training, procedures etc., but that's apples and oranges. We might all play baseball, but when the **** hits the fan, we are MLB and they are minor league.

We should make it clearer to the public that the reason you want an anesthesiologist is the same you want a Sully Sulberger as your pilot: for those rare situations when an "overtrained" physician will be the difference between life and death. The ASA should actively advertise to the general public that the healthcare industry is trying to make more profit by replacing anesthesiologists with CRNAs, risking lives, without decreasing healthcare costs to the patient. That's where I want to see the ASAPAC money going. Once the public opinion tide turns, the politicians will have no choice but to turn, too.

P.S. The VA is a disgrace. No quality care should ever be modeled on them. I felt so bad for those people, for how much they gave for us, and how little we do for them.

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Actually hospital administrators do know. They are just don't want to pay up for the difference.
They are trying real hard to redefine quality so by the new metrics there is no difference.
That is how they will have enough cover to switch to midlevel intensive models wherever they can.
Not quite there yet. But they are working on it.

I agree, dr doze. This is all a big experiment to see if they can get away with it. Anesthesia is just one of the first guinea pigs, with many other specialties to follow.

The only thing to stop them are patient deaths. You know the kind we prevent weekly when we walk in on an "experienced" CRNA doing something stupid, such as not recognizing patient agitation as being due to hypoxemia of less than 40%, during an otherwise straightforward MAC case.

This murse has obviously never set foot in a VA hospital and seen for himself what kind of "high level of care" the federal government has in mind for veterans. Anyone with a functioning eyeball would see exactly why CRNAs are so popular there.

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That seems to be a metaphor for every politician trying to underwrite our healthcare today.

Not only that, but they look down on regular nurses, like they are not one of them.

I think the greater problem might be that the public has no idea that anesthesiologists are physicians. They think the surgeon has a team of nurses whom he coordinates in the OR, including anesthesia.

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I agree with FFP. Actually, all of my attending's saw the patient and filled out the anesthesia preop and discussed the plan with the patient. If they had a resident, then they would relieve the resident to go and do the preop. Some attendings were a little extreme and would't even let the nurses place IVs. They made it very clear to them that their job was to do exactly what they told them to do: chart while the attending did the a lines, epidurals, etc. One of the NPs was "forced to leave" shortly after he got his DNP and started calling himself "Doctor." The division chief did not think it was appropriate. They now only hire PAs.

That's exactly how it should be, and the opposite of how it usually is. Where I work, the doctor is the preop monkey, and the nurse does almost whatever she wants, unpunished. One cannot supervise properly 3 rooms with 1 hour-cases.